July 13, 2014

Dementia and Depression: How to Get a “Fully Baked” Diagnosis 
by Carole B Larkin, Alzheimer’s Reading Room Blog

Real differences abound in diagnoses -- the "half baked" diagnosis and the "full baked" diagnosis. A half baked diagnosis is a doctor who asks a few memory questions and then says,”Yes, you have dementia. Here, take this.” He gives you a prescription for Aricept or one of the other four FDA approved drugs. A full baked diagnosis consists of three parts:

An MRI or similar scan. Two things can be seen on the scan. The first is white spots indicating that a “mini-stroke” (or TIA) has taken place in that area of the brain. The importance of finding mini-strokes is that none of the four FDA approved medicines do any good when someone has had a mini stroke.

If you are prescribed one or more of the drugs approved to treat Alzheimer's and your loved one has Vascular Dementia (dementia coming from mini or regular strokes in the brain) you are just throwing money on a "half baked diagnosis". A better use of your money might be to give your loved one something that they really love and that brings them momentary happiness? (Dark chocolate for me!)

An MRI will also show atrophy of the brain (the brain shrinking). If the brain has shrunk you can see an actual space on the MRI between the brain and the skull bones. I call that the “Air Gap”. After all, dead brain cells are skinnier than live brain cells, so they take up less space in the head. If the front of the brain (behind your forehead) has a bigger air gap than the middle or back part of the brain; then the diagnosis may be in part, Frontotemporal Dementia, which is different from straight Alzheimer’s. A neurologist that deals with Frontotemporal Dementia should be the doctor consulted for medicines appropriate to that disease.

Specific blood work looking for other things that can cause dementia, like thyroid deficiency, B12 deficiency, potassium deficiency, and other types of chemical imbalances showing up in the blood. These things can be correctible, thus ending the dementia.

Finally, a series of verbal and physical tests that not only test memory, but also test executive skills, such as: time/space orientation, attention span, concentration abilities, and expressive language ability among others. These tests take between two and four hours to complete.

Only if all of the above are done, do you get a true diagnosis, at this point in time. I’m sure that more tests will be done in the future to be able to further refine the diagnosis but right now that’s all we have available to most people. The special PET and other imaging scans are usually done for research purposes and are cost prohibitive for most people. Eventually I hope we have them available on a regular basis.

So this afternoon I have learned that I have given my mother a ‘half-baked’ diagnosis. Although it’s the best I can do, especially considering my lack of medical training, it’s completely inefficient in determining the exact nature of her current illness. She’s too ill and too weak to go through a series of tests, or even to get to a doctor’s office. I wish we hadn’t waited so long. I wish I had known years ago all that I have learned this week!

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